Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Abstract

<jats:p>Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.</jats:p>

A Case of Ventral Spinal Cord Herniation from a Chronic Dural-pleural Fistula Resulting in Thoracic Myelopathy

“…Interventions include primary repair or use of cadaveric graft, muscle flaps, or omental flaps [2,4,6,10,11]. The repair can be augmented with a secondary layer of sealants such as fibrin glue, epidural blood patch, Tisseel, DuraSeal (Integra Lifesciences, Plainsboro, NJ), or Onyx (Medtronic-Covidien, Minneapolis, MN) [1,6,8,12]. Alternatively, noninvasive positive pressure mask ventilation combined with chest tube drainage can be used to increase intrathoracic pressure, which decreases CSF flow by decreasing the pressure gradient between the subarachnoid and pleural spaces [5,13].…”

“…Thoracic dural-pleural fistula is rare a condition caused by injuries to the dura, which results in cerebrospinal fluid (CSF) leaking into the pleural cavity and leading to fistula formation. Development of the fistula is related to abnormal communication between the pleura and thoracic dura due to complications related to trauma, malignancy, or anterior or anterolateral approaches to the thoracic spine [1]. Negative pressure within the pleura induces a pressure differential that allows flow from the higher pressure subarachnoid space into a low-pressure pleura [2].…”

Diagnose and treatment of traumatic pleural-subarachnoid fistula in children: A case report and systematic review

“…Treatments for PSF include surgery and non-surgery. Although surgical treatment is a little more common than non-surgery strategy, there are more kinds of conservative measurements including thorax drainage, lumbar cisterna drainage, keeping supine position [ 10 ], epidural blood patch [ 12 , 14 ], positive pressure ventilation [ 15 – 18 ], biological glue injection percutaneously [ 19 , 20 ], and so on. Percutaneous injection of biological glue was newly reported treatment.…”

A Study of Safety and Effectiveness of Evicel Fibrin Sealant as an Adjunctive Hemostat in Pediatric Surgery

“…14,15 In EU, Evicel is also indicated as suture support in vascular surgery and for suture line sealing in dura mater closure; however, it is not yet approved in children. 15 Observational data have supported the efficacy of FSs as sealants/adhesives in children treated for dural puncture leakage, 16,17 peritoneal catheter cuff leakage, [18][19][20] and other conditions, [21][22][23][24][25][26] and these studies did not raise any safety concerns. A shortage of clinical data exists, however, on the use of FSs to control intraoperative bleeding in pediatric patients.…”